Haematological malignancies

Question 1

What is the most common malignancy in children?

Answer 1

Acute lymphoblastic leukaemia

Question 2

What are the symptoms of acute leukaemia?

Answer 2

1) Symptoms of bone marrow failure 
–  Anaemia
–  Thrombocytopenia (bleeding)
–  Neutropenia (infections)
(Note WBC may be high, normal or low)

2) Symptoms related to tissue infiltration
– Lymphadenopathy
- Hepatosplenomegaly
– Gum hypertrophy
– Rash, subcutaneous chloromas
– CNS involvement (cranial nerve palsies, meningism)

Question 3

Which type of leukaemia is caused by translocation of bcr-abl?

Answer 3

Chronic myeloid leukaemia

Question 4

What does basophilia suggest the diagnosis is?

Answer 4

Chronic myeloid leukaemia

Question 5

What is the targeted therapy for CML?

Answer 5

Glivec/Imatinib (TK inhibitor)

Question 6

Which cells are usually affected in CLL?

Answer 6

B lymphocytes

Question 7

How are lymphomas categorised histologically?

Answer 7

High grade or low grade

Question 8

Which cancer regularly causes bone lesions?

Answer 8

Myeloma

Question 9

What symptoms may be seen in multiple myeloma?

Answer 9

- Fatigue/anaemia
–  Bone pain/pathological fracture 
–  Symptoms of hypercalcaemia
–  Symptoms of hyperviscosity
 –  Renal failure

Question 10

What kind of lymphoma is Bcl-2 positive?

Answer 10

Follicular lymphoma

Question 11

What are the main dangers of leukaemia?

Answer 11

Neutropenia and sepsis
Tumour Lysis Syndrome
Hyperviscosity- leading to leukostasis
DIC

Question 12

Which leukaemia is associated with myelodysplastic states?

Answer 12

AML

Question 13

What is the 3 year survival for patients with AML, following treatment?

Answer 13

20%

Question 14

Which leukaemia is associated with DIC?

Answer 14

Acute promyelocytic leukaemia (a subtype of AML, in which there is a release of thromboplastin)

Question 15

Auer rods are diagnostic of which leukaemia?

Answer 15

AML

Question 16

What is the commonest leukaemia?

Answer 16

CLL

Question 17

What are the 3 complications of CLL

Answer 17

1) Autoimmune haemolysis
2) Infection due to hypogammaglobulinaemia.
3) Marrow failure

Question 18

In what kind of blood cancer are Reed-Sternberg cells found?

Answer 18

Hodgkin’s lymphoma

Question 19

A stage III B lymphoma, using the Ann Arbor system =?

Answer 19

Involvement of LN on both sides of diaphragm and presence of B symptoms.

Question 20

What are the B symptoms?

Answer 20

1) Weight loss of >10% over 6 months, unexplaned fever >38deg, drenching night sweats.

Question 21

How is Hodgkin’s lymphoma stage I-A and II-A treated?

Answer 21

Radiotherapy +/- short courses of chemotherapy.

Question 22

How are Hodgkin’s lymphoma stage II-A with >3 node) through to IV-B treated?

Answer 22

Long course chemotherapy: ABVD

Question 23

What is the commonest NHL?

Answer 23

Diffuse Large B Cell Lymphoma (DLBCL)

Question 24

What causes NHL?

Answer 24

Immunodeficiency: drugs, HIV (EBV transformed cells), HTLV-1, H.Pylori, toxins, congenital

Question 25

What is Sezary syndrome?

Answer 25

A cutaneous T cell lymphoma. Cells have pathological quantities of mucopolysaccharides

Question 26

What patterns of extranodal disease exist in NHL?

Answer 26

Skin: T cell lymphomas Oropharynx: Waldeyer's ring lymphoma Gut: 1) Gastric MALT, 2) Non-MALT gastric lymphomas, 3) Small-bowel lymphomas Other possible sites: lung, bone, CNS

Question 27

Which NH lymphoma has characteristic jaw lymphadenopathy?

Answer 27

Burkitt's lymphoma

Question 28

What treatment regime is used for high grade Non-Hodgkin's lymphomas?

Answer 28

R-CHOP

Question 29

What causes the osteolytic lesions in myeloma?

Answer 29

Increased osteoclast activity, due to signalling by myeloma cells

Question 30

In which type of blood cancer do we see rouleaux formation?

Answer 30

Myeloma

Question 31

What are the complications of myeloma?

Answer 31

1) Hypercalcemia 2) Spinal cord compression 3) Hyperviscosity 4) Acute renal injury